Healthcare Provider Details

I. General information

NPI: 1922238989
Provider Name (Legal Business Name): MISS SIU MUI CARMAN CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S MICHIGAN AVE
CHICAGO IL
60616-5018
US

IV. Provider business mailing address

2850 S MICHIGAN AVE
CHICAGO IL
60616-5018
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-2129
  • Fax: 312-225-6324
Mailing address:
  • Phone: 312-949-2129
  • Fax: 312-225-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number164004507
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: